Legislation that would limit Medicaid expansion in Idaho by requiring some recipients to work and others to keep private insurance was introduced Monday.

Nampa Republican Rep. John Vander Woude introduced the bill in the Idaho House Health and Welfare Committee. A hearing on the measure is expected Wednesday.

In addition to a 20-hour-per-week work minimum, the bill would require people who are between 100 percent and 138 percent of the federal poverty level to continue paying for private insurance on the state-run health exchange. That requirement would be lifted only if the state fails to get federal approval for the plan by the start of next year, in which case those individuals would be moved to Medicaid coverage.

The legislation is one of many proposals from Republicans seeking to add sideboards to the voter-approved initiative expanding Medicaid coverage to those who previously earned too much to qualify but too little to afford private insurance on the state health care exchange.

A previous version of the bill included a 30-hour work requirement and would allow people between 100-138 percent of the federal poverty level to choose whether or not to stay on the state exchange or make the switch to Medicaid.

Vander Woude said he liked the earlier version of the bill that gave some people the choice of whether to move to Medicaid, but felt that compelling them to stay on the state exchange would be better for the state financially. He said he wasn’t sure whether the new requirement was enough to encourage his reluctant Republican colleagues in the House to pass a separate Medicaid expansion funding package, however.

“Without sideboards I think the funding may fail, and then the governor doesn’t let us sine die (adjourn),” Vander Woude said after a Monday committee meeting. “This is just to see if there’s enough votes to move this forward or not.”

During the committee meeting, Vander Woude said the state health care exchange estimates that there are about 10,000 residents who have the ability to enroll in subsidized coverage on the state exchange but haven’t ever signed up.

Boise Democratic Rep. Ilana Rubel asked whether barring those people from Medicaid would create a secondary coverage gap and push the burden of covering emergency health care costs to the counties, via the state’s catastrophic health care fund.

Vander Woude said he suspected someone who could buy subsidized health insurance but refuses should be denied access to the catastrophic funds, but that language isn’t included in the bill. That health care fund helps counties pay for the costliest cases when residents who can’t pay their catastrophic medical bills apply for financial assistance. Proponents of Medicaid expansion have said it would help ease reliance on the fund.

The committee chairman, Republican Rep. Fred Wood, of Burley, said the committee would hold a hearing on the bill Wednesday morning.

“We are going to get a chance to sort all of this out, and everybody will get a chance to have their say, and we’re going to stay there until the last bell is rung, OK?” he told the committee.

Medicaid expansion has long been a contentious issue in Idaho. For years the Republicans in the Legislature refused to consider expanding coverage, as allowed under the Affordable Care Act. Last year a grass-roots effort put Proposition 2 on the ballot to expand Medicaid, and it passed overwhelmingly, with 61 percent in favor.

Prop 2’s wording is what’s known as a “clean” Medicaid expansion – it contains no language about adding work requirements or other stipulations for eligibility.

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Republican introduces bill to restrict Medicaid expansion; hearing set for Wednesday – Idaho Statesman